# Do health insurance plans in the US cover abortion? **URL:** \ **Category:** Factual Questions\ **Created:** [December 3, 2021, 7:34pm UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465 "2021-12-03T19:34:11Z")\ **Posts on this page:** 12\ **Page:** 1
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [December 3, 2021, 7:34pm UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/1 "2021-12-03T19:34:11Z")
Just looking for factual responses please. Is this something that is standard coverage, or do different health plans treat it differently? ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [December 3, 2021, 7:40pm UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/2 "2021-12-03T19:40:05Z")
Varies by state. As per the Kaiser Family Foundation, some states restrict private health insurance plans from covering abortion services, unless the mother’s health is in danger; a handful of states mandate that private insurance plans _must_ cover abortion services. > [@](#): > > States have the responsibility to regulate fully insured individual, small, and large group plans issued in their state, whereas the federal government regulates self-insured plans under the Employee Retirement Income Security Act (ERISA). States can choose to regulate whether abortion coverage is included or excluded in private plans that are not self-insured. In the private insurance sector, 11 states impose restrictions on the circumstances under which insurance will cover abortions ( **[Appendix](https://www.kff.org/report-section/coverage-for-abortion-services-in-medicaid-marketplace-plans-and-private-plans-appendix/) Table 1** ). Some states follow the same restrictions as the federal Hyde Amendment for their private plans, while some are more restrictive. [Idaho](https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH18/SECT41-1848/) has exceptions for cases of rape, incest, or to save the woman’s life for plans sold on the Marketplace, but limits abortion coverage to cases of [life endangerment](https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH34/SECT41-3439/) to the woman for all other private plans issued in the state. [Utah](https://le.utah.gov/~2011/bills/hbillenr/hb0354.pdf) has exceptions to save the life of the mother or avert serious risk of loss of a major bodily function, if the fetus has a defect as documented by a physician that is uniformly diagnosable and lethal, and in cases of rape or incest. However, six states ([Kansas](http://www.kslegislature.org/li_2012/b2011_12/measures/documents/hb2075_enrolled.pdf), [Kentucky](https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=16769), [Missouri](http://revisor.mo.gov/main/OneSection.aspx?section=376.805&bid=20811), [Nebraska](https://nebraskalegislature.gov/FloorDocs/102/PDF/Final/LB22.pdf), [North Dakota](https://www.legis.nd.gov/cencode/t14c02-3.pdf?20131212103005), and [Oklahoma](https://law.justia.com/codes/oklahoma/2014/title-63/section-63-1-741.3/)) have an exception only to save the woman’s life for all fully insured private plans regulated by the state. [Michigan](http://www.legislature.mi.gov/(S(f2k4n4l3t0jzd0uwmh2x2e3z))/mileg.aspx?page=GetObject&objectname=mcl-Act-182-of-2013) allows abortion coverage in cases of life endangerment, in cases involving a pregnancy reduction for a multi-fetal pregnancy when the abortion increases the probability of a live birth, or preserves the life or health of the child after live birth.[15](https://www.kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-in-medicaid-marketplace-plans-and-private-plans/view/footnotes/#footnote-410520-15) [Texas](https://capitol.texas.gov/tlodocs/851/billtext/html/HB00214I.htm) allows abortion coverage only in the cases of severe health endangerment or life endangerment. Five states had these laws on the books prior to the ACA, and six more states have passed new laws restricting private plan coverage post-ACA. While ten of these states allow insurers to sell riders for abortion coverage on the private market, a Kaiser Family Foundation [study](https://www.kff.org/womens-health-policy/issue-brief/abortion-riders-women-living-in-states-with-insurance-restrictions-lack-abortion-coverage-options/) found that in 2018, no insurers offered abortion riders to women insured through individually purchased plans, and only one insurance company in one state offered an abortion rider in the group market. The lack of abortion riders leaves women insured by private plans in these states with no option to secure coverage for abortion services. [Utah](https://le.utah.gov/~2011/bills/hbillenr/hb0354.pdf) does not allow riders to be sold for abortion coverage. > > There is no recent data on the number of private plans that include abortion coverage. Only four states (California, New York, Oregon, and Washington) require all state-regulated private health plans, including Marketplace plans, to include coverage for abortion.[16](https://www.kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-in-medicaid-marketplace-plans-and-private-plans/view/footnotes/#footnote-410520-16) Maine enacted a [law](http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=HP0594&item=1&snum=129) that requires all private health insurance plans renewed on or after January 1, 2020 that cover maternity care to cover abortion services.[17](https://www.kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-in-medicaid-marketplace-plans-and-private-plans/view/footnotes/#footnote-410520-17) California and Washington require all plans including individual and employer plans to treat abortion coverage and maternity coverage neutrally. As all plans are required to include maternity coverage, all plans must also include abortion coverage.[18](https://www.kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-in-medicaid-marketplace-plans-and-private-plans/view/footnotes/#footnote-410520-18),[19](https://www.kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-in-medicaid-marketplace-plans-and-private-plans/view/footnotes/#footnote-410520-19) Also from the same site, regarding ACA (Obamacare) plans for individuals: > [@](#): > > All plans offered on the ACA Marketplaces must provide coverage for 10 Essential Health Benefits (EHB), including maternity care and prescription drugs. Abortion services, however, are explicitly excluded from the list of EHBs that all plans are required to offer. Under federal law, no plan is required to cover abortion. States can enact laws that bar all plans participating in the state Marketplace from covering abortions, which 26 states have done since the ACA was signed into law in 2010 **(Figure 2).** Most state laws include narrow exceptions for women whose pregnancies endanger their life or are the result of rape or incest, but two states (Louisiana and Tennessee) do not provide for any exceptions.[20](https://www.kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-in-medicaid-marketplace-plans-and-private-plans/view/footnotes/#footnote-410520-20) The ACA prohibits plans in the state Marketplaces from discriminating against any provider because of “unwillingness” to provide abortions. > > In a review of 2019 Marketplace plans, eight states that do not have laws restricting abortion coverage (Delaware, Iowa, Illinois, Minnesota, New Mexico, Nevada, West Virginia, and Wyoming), had no Marketplace plans that offered abortion coverage ( **Figure 2** ). In the five states (Connecticut, Hawaii, Maryland, New Hampshire, and Vermont) and the District of Columbia that have no laws banning on requiring abortion coverage, all of the 2019 Marketplace plans include abortion coverage. Four states (California, New York, Oregon, and Washington) require abortion coverage from plans on the marketplace. As of January 1, 2020, abortion coverage will be required on the Marketplace in Maine. There are seven states (Alaska, Colorado, Maine,[21](https://www.kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-in-medicaid-marketplace-plans-and-private-plans/view/footnotes/#footnote-410520-21) Massachusetts, Montana, New Jersey, and Rhode Island) that do not require abortion coverage and offer at least one plan on the Marketplace that includes abortion coverage. For women in these seven states, the actual availability of coverage depends on whether there is a plan offered in their area that includes abortion services. As a combined result of the state laws and insurance company choices, women in 34 states currently do not have access to insurance coverage for abortions through a Marketplace plan – the only place where consumers can qualify for tax subsidies to help pay for the cost of health insurance premiums if they are income eligible. > **[Coverage for Abortion Services in Medicaid, Marketplace Plans and Private...](https://www.kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-in-medicaid-marketplace-plans-and-private-plans/)** > > This brief reviews current federal and state policies on Medicaid and insurance coverage of abortion services and presents national and state estimates on the availability of abortion coverage for women enrolled in private plans, Affordable Care Act... ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [December 3, 2021, 7:42pm UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/3 "2021-12-03T19:42:42Z")
Fascinating. Weird ass complicated, but fascinating. Thanks. ---
**Author:** ![RitterSport](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rittersport/32/6326_2.png) [@RitterSport](https://boards.straightdope.com/u/RitterSport)\ **Post date:** [December 3, 2021, 7:44pm UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/4 "2021-12-03T19:44:27Z")
I’m shocked that a healthcare issue in the US would be complicated! ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [December 3, 2021, 8:12pm UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/5 "2021-12-03T20:12:16Z")
> [@Northern\_Piper](#): > > Fascinating. Weird ass complicated, but fascinating. Thanks. You are welcome! I kinda-sorta work in the industry: I am an advertising strategist, but my primary client, for the past six years, has been a major regional health insurance company (and I worked with several different health insurers at a previous job). Yeah, anything regarding the U.S. health insurance industry is “weird ass complicated.” I have a presentation that I wrote a few years ago, that I use to help colleagues who move onto our account, to get them up to speed on how health insurance works. I always preface that conversation by saying, “No sane person would set out to put together an industry this way from scratch; it’s the result of a hundred years of market evolution, governmental regulations, and political pressures.” ---
**Author:** ![md-2000](https://avatars.discourse-cdn.com/v4/letter/m/9d8465/32.png) [@md-2000](https://boards.straightdope.com/u/md-2000)\ **Post date:** [December 5, 2021, 7:49am UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/6 "2021-12-05T07:49:20Z")
> [@RitterSport](#): > > I’m shocked that a healthcare issue in the US would be complicated! based on what I see in ads on CNN, I am not the least surprised. What most surprises me, maybe, is all the extended Medicare stuff. Wasn’t the whole point of Medicare to not need health insurance? But I guess the private companies want their share of the pork pie. ---
**Author:** ![bob\_2](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bob_2/32/3341_2.png) [@bob\_2](https://boards.straightdope.com/u/bob_2)\ **Post date:** [December 5, 2021, 1:19pm UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/7 "2021-12-05T13:19:54Z")
It may be worth mentioning that even in the UK, with UHC, most (95%) abortions are publically funded. Women wishing to terminate a pregnancy usually either see their GP or visit a charity such as Marie Stopes. Both will arrange for an NHS abortion provided that the termination is legal. ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [December 5, 2021, 5:21pm UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/8 "2021-12-05T17:21:35Z")
> [@md-2000](#): > > Wasn’t the whole point of Medicare to not need health insurance? While it covers a lot of things, “Original Medicare” doesn’t cover everything – there are still deductibles and co-pays, and there are some services that it doesn’t cover at all. That’s where the private Medicare supplement and Medicare Advantage plans come in. ---
**Author:** ![kaylasdad99](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kaylasdad99/32/3398_2.png) [@kaylasdad99](https://boards.straightdope.com/u/kaylasdad99)\ **Post date:** [December 11, 2021, 4:23am UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/9 "2021-12-11T04:23:19Z")
And not that many patients on Medicare tend to find themselves in a situation where abortion is an option. ---
**Author:** ![md-2000](https://avatars.discourse-cdn.com/v4/letter/m/9d8465/32.png) [@md-2000](https://boards.straightdope.com/u/md-2000)\ **Post date:** [December 11, 2021, 6:40am UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/10 "2021-12-11T06:40:19Z")
> [@bob\_2](#): > > It may be worth mentioning that even in the UK, with UHC, most (95%) abortions are publically funded. > > Women wishing to terminate a pregnancy usually either see their GP or visit a charity such as Marie Stopes. Both will arrange for an NHS abortion provided that the termination is lega Canada is more interesting - the supreme court here has ruled abortion is a woman’s right; and further decision said that since Medicare pays for all medical procedures, it must pay for those; and must also ensure the procedure is accessible anywhere without regional disparities. There are a number of services not covered by UHC - dental, prescriptions, birth control, and in some provinces chiropractors… But generally, there is some government program to cover the necessities for those who cannot afford them. Employer benefits generally include dental, prescriptions, and eyeglasses - for the better paying jobs. Minimum wage? Sucks to be you. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [December 11, 2021, 8:53pm UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/11 "2021-12-11T20:53:13Z")
I just renewed my health insurance and was reviewing the terms the other day. Abortion is only covered in cases where the mother’s life would be in danger if she continued the pregnancy as certified by a physician. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [December 11, 2021, 10:38pm UTC](https://boards.straightdope.com/t/do-health-insurance-plans-in-the-us-cover-abortion/955465/12 "2021-12-11T22:38:30Z")
> [@UltraVires](#): > > Abortion is only covered in cases where the mother’s life would be in danger if she continued the pregnancy as certified by a physician. I doubt that they will investigate the physician’s reasons all that much. An abortion is generally going to be far cheaper than a delivery. I’d also wonder if they would okay it if it weren’t that the danger from the pregnancy wasn’t death, but “merely” a lifetime debility.